Growth and Development Pediatrics: Toddler to Adolescence Notes

Toddler growth and development (1-3 years)

  • Age milestones

    • 12–14 months: walks without support; may crawl upstairs; bends over to look between legs; squatting position during play. 12–14 months12\text{--}14 \text{ months}
    • 15 months: walks without losing balance; begins to use a spoon; builds a tower of 2 blocks with good release; enjoys throwing things on the floor; begins to walk sideways and backwards; scribbles. 15 months15 \text{ months}
    • 18 months: starts running with wide base of support; goes up and down stairs with 2 feet on a step; fine motor coordination improving. 18 months18 \text{ months}
    • 2 years: throws and catches a ball; builds a tower of blocks as tall as he is; runs well; gained 4–6 lbs in last year; helps with dressing and undressing; vocabulary increasing: can hand you objects by name. 2 years2 \text{ years}

  • Communication and social development (Toddler 1–3 yr)

    • By 3 years: ~900 words900\text{ words} with ~75% intelligible75\% \text{ intelligible} speech
    • Imitative speech; understands 2-step commands and opposites
    • Social: insatiable curiosity; interacts with family; bubbly laughter; dependence on security item

  • Nutrition & feeding

    • 3 meals & snacks daily
    • Uses cups and utensils

  • Sleep

    • 10–12 hours at night and a daytime nap

  • Vital signs (typical toddler ranges)

    • Respiratory rate: 25–30 /min25\text{--}30\,/\text{min}
    • Heart rate: 80–130 /min80\text{--}130\,/\text{min}
    • Blood pressure: 69–115/38–92 mmHg69\text{--}115/38\text{--}92\,\text{mmHg}

  • Gross motor development (ages 2–6)

    • Running; stair climbing; jumping; hopping; skipping; ball skills; throwing, catching, kicking
    • Concept: Motor development involves goal-directed movement patterns performed with proficiency; improvement occurs with specific practice; motivation, instruction and practice are critical

  • Fine motor development (ages 2–6)

    • Hand preference emerges
    • Grasp and manipulation of writing instruments
    • Grip strength, manual dexterity, bilateral coordination, and eye–hand coordination

Pre-Schooler (3–5 years)

  • Communication

    • Talks incessantly; exaggerates, boasts, tattles
    • Recognizes own written name
    • By ~5 years: connected sentences
    • Understands simple explanations; understands opposites and direction; knows own age

  • Social development

    • Temper tantrums decrease; may be selfish and impatient
    • Imaginary playmates; tries to follow rules; developing a conscience; learning to share
    • Plays independently and with peers; fear of separation from family & home

  • Nutrition & feeding

    • 3 meals & snacks; feeds self

  • Sleep

    • 11–12 hours per night; daytime nap variable

  • Vital signs (typical preschooler ranges)

    • Respiratory rate: 21–23 /min21\text{--}23\,/\text{min}
    • Heart rate: 75–115 /min75\text{--}115\,/\text{min}
    • Blood pressure: 78–115/48–80 mmHg78\text{--}115/48\text{--}80\,\text{mmHg}

  • Motor development

    • Gross motor: continued refinement of running, climbing, jumping, balancing, throwing, catching, kicking; gains in balance and coordination
    • Fine motor: improved manual dexterity; drawing and writing readiness; use of utensils with increasing independence

School Age (7–12 years)

  • Growth and physical changes

    • Boys: gain 35−−40 lbs35--40\,\text{lbs}; grow 9−−12 inches9--12\,\text{inches}
    • Girls: gain 40−−45 lbs40--45\,\text{lbs}; grow 10−−15 inches10--15\,\text{inches}
    • By 6 years of age: body proportions change; vision becomes keener; brain development is nearly complete

  • Communication and social development

    • Acts silly; begins search for independence; seeks heroes/role models
    • Easily distracted; enjoys structure and rules; values peers; becomes competitive
    • Play: competitive sports; interacts with peers of both sexes

  • Nutrition and appetite

    • Appetite greatly increases during rapid growth (≈ 10–12 years)

  • Sleep

    • Sleep varies: about 8–12 hrs/night8\text{--}12\,\text{hrs/night}

  • Vital signs (typical school-age ranges)

    • Respiratory rate: 19–21 /min19\text{--}21\,/\text{min}
    • Heart rate: 75–110 /min75\text{--}110\,/\text{min}
    • Blood pressure: 85–131/48–69 mmHg85\text{--}131/48\text{--}69\,\text{mmHg}

Adolescence (12–18 years)

  • Overview

    • Physical: a period of transition between childhood and adulthood
    • Pubescence: ~2 years of rapid physiological growth as reproductive functions mature
    • Puberty: point at which an individual is able to reproduce

  • Sex-specific growth and development

    • Females
    • Pubescence typically about 6 months earlier than males; puberty occurs about 2 years earlier than in males
    • Growth spurt: gains 20−−25 lbs20--25\,\text{lbs} and height gain of 4−−5 inches4--5\,\text{inches}; adult height by 18 years
    • Hips broaden; scalp hair increases; breast enlargement (permanent)
    • Uterus and vagina enlarge and thicken
    • Menarche: initially anovulatory for the first 1−−3 years1--3\,\text{years}, broad range 10−−16 years10--16\text{ years}
    • Males
    • Major growth spurt: height gain 7−−11 inches7--11\,\text{inches}; weight gain 55−−75 lbs55--75\,\text{lbs}; larger increase in muscle mass
    • Nocturnal emissions; shoulders broaden; voice deepens
    • Common changes for both sexes
    • Muscles enlarge and strength increases (more in males)
    • Body hair increases (more in males)
    • Lung size and vital capacity increase
    • Gonads enlarge and secrete
    • Teenagers are more concerned about physical appearance than anything else

  • Communication and social development

    • Interest in opposite gender; intense concern over physical appearance
    • Able to gain attention of peers and adults in acceptable ways; peer acceptance is crucial; role models
    • Idealistic; need for privacy; vacillates between dependence and independence; develops logical thought and deductive reasoning

  • Play and activities

    • Play becomes more complex and varied: freedom, mobility, socializing, dating, sports, dancing, music, etc.

  • Nutrition and weight concerns

    • Nutrition varies with growth and activity; may follow food fads; concerned about weight

  • Sleep

    • Typically requires more sleep during rapid growth; usually 8−−12 hours8--12\,\text{hours} per night; may include late nights and sleeping in

  • Vital signs (typical adolescent ranges)

    • Respiratory rate: 16−−19 /min16--19\,/\text{min}
    • Heart rate: 70−−110 /min70--110\,/\text{min}
    • Blood pressure: 95−−140/49−−71 mmHg95--140/49--71\,\text{mmHg}

  • Adolescent pain behavior

    • Wide variation in how pain is expressed
    • May show withdrawal or manipulation; decreased appetite or poor hygiene; possible refusal of care
    • Able to describe pain; may verbalize desire for pain medications except in front of peers

  • Notes on social/psychological themes

    • Identity formation, autonomy, privacy, peer influence, and evolving body image are central concerns during adolescence